A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center

Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decre...
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Gespeichert in:

Autor*in:	Antonio Gonzalez Fiol [verfasserIn] Pedro Acevedo Rodriguez [verfasserIn] Xiwen Zhao [verfasserIn] Robert Gaiser [verfasserIn] Adriana Herrera [verfasserIn] Aymen Alian [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound

Übergeordnetes Werk:	In: POCUS Journal - CINQUILL Medical Publishers Inc., 2022, 8(2023), 2
Übergeordnetes Werk:	volume:8 ; year:2023 ; number:2

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.24908/pocus.v8i2.16298

Katalog-ID:	DOAJ100970788

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520			\|a Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology.
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spelling	10.24908/pocus.v8i2.16298 doi (DE-627)DOAJ100970788 (DE-599)DOAJac674f253ca94ea6b9288502853e01a3 DE-627 ger DE-627 rakwb eng RC31-1245 R855-855.5 Antonio Gonzalez Fiol verfasserin aut A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology. Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound Internal medicine Medical technology Pedro Acevedo Rodriguez verfasserin aut Xiwen Zhao verfasserin aut Robert Gaiser verfasserin aut Adriana Herrera verfasserin aut Aymen Alian verfasserin aut In POCUS Journal CINQUILL Medical Publishers Inc., 2022 8(2023), 2 (DE-627)1816009946 23698543 nnns volume:8 year:2023 number:2 https://doi.org/10.24908/pocus.v8i2.16298 kostenfrei https://doaj.org/article/ac674f253ca94ea6b9288502853e01a3 kostenfrei https://ojs.library.queensu.ca/index.php/pocus/article/view/16298 kostenfrei https://doaj.org/toc/2369-8543 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_138 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_187 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_647 GBV_ILN_702 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 2
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allfieldsGer	10.24908/pocus.v8i2.16298 doi (DE-627)DOAJ100970788 (DE-599)DOAJac674f253ca94ea6b9288502853e01a3 DE-627 ger DE-627 rakwb eng RC31-1245 R855-855.5 Antonio Gonzalez Fiol verfasserin aut A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology. Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound Internal medicine Medical technology Pedro Acevedo Rodriguez verfasserin aut Xiwen Zhao verfasserin aut Robert Gaiser verfasserin aut Adriana Herrera verfasserin aut Aymen Alian verfasserin aut In POCUS Journal CINQUILL Medical Publishers Inc., 2022 8(2023), 2 (DE-627)1816009946 23698543 nnns volume:8 year:2023 number:2 https://doi.org/10.24908/pocus.v8i2.16298 kostenfrei https://doaj.org/article/ac674f253ca94ea6b9288502853e01a3 kostenfrei https://ojs.library.queensu.ca/index.php/pocus/article/view/16298 kostenfrei https://doaj.org/toc/2369-8543 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_138 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_187 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_647 GBV_ILN_702 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 2
allfieldsSound	10.24908/pocus.v8i2.16298 doi (DE-627)DOAJ100970788 (DE-599)DOAJac674f253ca94ea6b9288502853e01a3 DE-627 ger DE-627 rakwb eng RC31-1245 R855-855.5 Antonio Gonzalez Fiol verfasserin aut A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology. Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound Internal medicine Medical technology Pedro Acevedo Rodriguez verfasserin aut Xiwen Zhao verfasserin aut Robert Gaiser verfasserin aut Adriana Herrera verfasserin aut Aymen Alian verfasserin aut In POCUS Journal CINQUILL Medical Publishers Inc., 2022 8(2023), 2 (DE-627)1816009946 23698543 nnns volume:8 year:2023 number:2 https://doi.org/10.24908/pocus.v8i2.16298 kostenfrei https://doaj.org/article/ac674f253ca94ea6b9288502853e01a3 kostenfrei https://ojs.library.queensu.ca/index.php/pocus/article/view/16298 kostenfrei https://doaj.org/toc/2369-8543 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_138 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_187 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_647 GBV_ILN_702 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 2
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topic_facet	Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound Internal medicine Medical technology
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authorswithroles_txt_mv	Antonio Gonzalez Fiol @@aut@@ Pedro Acevedo Rodriguez @@aut@@ Xiwen Zhao @@aut@@ Robert Gaiser @@aut@@ Adriana Herrera @@aut@@ Aymen Alian @@aut@@
publishDateDaySort_date	2023-01-01T00:00:00Z
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issn	23698543
topic_title	RC31-1245 R855-855.5 A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center Neuraxial anesthesia Regional anesthesia Pregnancy ultrasound guided neuraxial anesthesia handheld ultrasound portable ultrasound
topic	misc RC31-1245 misc R855-855.5 misc Neuraxial anesthesia misc Regional anesthesia misc Pregnancy misc ultrasound guided neuraxial anesthesia misc handheld ultrasound misc portable ultrasound misc Internal medicine misc Medical technology
topic_unstemmed	misc RC31-1245 misc R855-855.5 misc Neuraxial anesthesia misc Regional anesthesia misc Pregnancy misc ultrasound guided neuraxial anesthesia misc handheld ultrasound misc portable ultrasound misc Internal medicine misc Medical technology
topic_browse	misc RC31-1245 misc R855-855.5 misc Neuraxial anesthesia misc Regional anesthesia misc Pregnancy misc ultrasound guided neuraxial anesthesia misc handheld ultrasound misc portable ultrasound misc Internal medicine misc Medical technology
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title	A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center
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title_full	A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center
author_sort	Antonio Gonzalez Fiol
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author_browse	Antonio Gonzalez Fiol Pedro Acevedo Rodriguez Xiwen Zhao Robert Gaiser Adriana Herrera Aymen Alian
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class	RC31-1245 R855-855.5
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author-letter	Antonio Gonzalez Fiol
doi_str_mv	10.24908/pocus.v8i2.16298
author2-role	verfasserin
title_sort	prospective cohort study to evaluate needle passes using a portable ultrasound device versus traditional landmark approach for epidural anesthesia in a busy obstetric tertiary care center
callnumber	RC31-1245
title_auth	A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center
abstract	Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology.
abstractGer	Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology.
abstract_unstemmed	Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology.
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title_short	A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center
url	https://doi.org/10.24908/pocus.v8i2.16298 https://doaj.org/article/ac674f253ca94ea6b9288502853e01a3 https://ojs.library.queensu.ca/index.php/pocus/article/view/16298 https://doaj.org/toc/2369-8543
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up_date	2024-07-03T17:45:51.366Z
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